UNIVERSITY OF UTAH PEDIATRIC SERVICES (NPI# 1255795308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255795308 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
| Other Organization Name | PEDIATRIC CARDIOTHORACIC SURGEONS |
| Practice Address |
81 N Mario Capecchi Dr Salt Lake City UT 84113-1125 |
| Mailing Address |
Po Box 841450 Los Angeles CA 90084-1450 |
| Practice Telephone | 8015876336 |
| Mailing Telephone | 8012133900 |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2020-05-20 |
| Authorized Official Name | EDWARD CLARK (DEPARTMENT CHAIR) |
| Authorized Official Telephone | 8015876336 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | UNIVERSITY OF UTAH PEDIATRIC SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Allopathic & Osteopathic Physicians | ||
| Y | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pediatric Cardiothoracic Surgeons | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669918769 | University of Utah Pediatric Services | Pediatrics | 1645 Pancheri Dr, Idaho Falls, ID 83402-3169 | 2017-01-12 |
| 1386257152 | University of Utah Pediatric Services | Orthopaedic Surgery | 9385 S Snowbird Center Dr, Sandy, UT 84092-6249 | 2020-08-31 |
| 1023542388 | University of Utah Pediatric Services | Pediatrics | 2360 Mullan Rd, Sutie C, Missoula, MT 59808-1811 | 2017-04-13 |
| 1760928865 | University of Utah Pediatric Services | Internal Medicine | 110 Vista Dr, Pocatello, ID 83201-5824 | 2017-01-12 |
| 1235675364 | University of Utah Pediatric Services | Urology | 1645 Pancheri Dr, Idaho Falls, ID 83402-3169 | 2017-01-12 |
| 1104370691 | University of Utah Pediatric Services | Transplant Surgery | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2016-08-12 |
| 1922552413 | University of Utah Pediatric Services | Surgery | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-08-12 |
| 1578017067 | University of Utah Pediatric Services | Pediatrics | 100 N Mario Capecchi Dr, 1, Salt Lake City, UT 84113-1103 | 2016-08-12 |
| 1568916054 | University of Utah Pediatric Services | Pediatrics | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-08-12 |
| 1245682509 | University of Utah Pediatric Services | Pediatrics | 98 Poplar St, Blackfoot, ID 83221-1758 | 2016-07-11 |
| Street Address |
81 N MARIO CAPECCHI DR |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84113-1125 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922012251 | Jeffrey Marvin Dalley | Social Worker | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2006-07-29 |
| 1255946588 | Sarah Elizabeth Roberts | Dietitian, Registered | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-09-14 |
| 1144835885 | Rachel Coffey | Social Worker | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-09-10 |
| 1457965865 | Mallory Caitlin Kidwell | Clinic/Center | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-09-02 |
| 1063021699 | Sara Stevenson | Dietitian, Registered | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-07-29 |
| 1780292318 | Katherine Ruesch | Nurse Practitioner | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-07-20 |
| 1124646062 | Nathaniel Edward Hayward | Student in an Organized Health Care Education/Training Program | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-07-07 |
| 1780209544 | Paul Clark Bluth | Student in an Organized Health Care Education/Training Program | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-06-08 |
| 1477177939 | Kristen Wong | Genetic Counselor, MS | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-06-01 |
| 1891316170 | Brianna Dougall | Registered Nurse | 81 N Mario Capecchi Dr, Salt Lake City, UT 84113-1125 | 2020-04-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386111060 | Melissa Marie Dixon | Psychologist | Primary Children's Hospital Outpatient Services, 81 South Mario Capecchi Drive, Salt Lake City, UT 84113 | 2018-10-31 |
| 1366965618 | Ashley Stuart | Psychologist | 44 North Mario Capecchi Drive, Salt Lake City, UT 84113 | 2017-07-19 |
| 1487945135 | Justin C Wheeler | Pediatrics | 81 N Mario Capecchi Dr Fl 4, Salt Lake City, UT 84113 | 2011-04-29 |
| 1154612117 | Dana Boucek | Pediatrics | 100 North Mario Capecchi Dr., Primary Children's, Salt Lake City, UT 84113 | 2011-04-26 |
| 1285959502 | Anna Katherine Eyre Ermarth | Pediatrics | 81 Mario Capecchi, Salt Lake City, UT 84113 | 2010-03-30 |
| 1457682072 | Elizabeth K Cho | Nurse Practitioner | 100 North Mario Cappechi Dr., Salt Lake City, UT 84113 | 2010-01-21 |
| 1528290848 | Nancy Crandell Brown | Nurse Practitioner | 100 North Mario Cappechi Drive, Salt Lake City, UT 84113 | 2009-08-20 |
| 1679708481 | Primary Children's Medical Center | General Acute Care Hospital | 100 No. Mario Capecchi Drive, Salt Lake, UT 84113 | 2009-05-22 |
| 1467697235 | Tara Hook | Physical Therapist | 100 North Mario Capecchi Dr, Salt Lake City, UT 84113 | 2008-12-09 |
| 1144474768 | Jennifer K Workman | Pediatrics | 100 N Mario Capecchi Drive, Pediatric Crtical Care, Primary Children's Hospital, Salt Lake City, UT 84113 | 2008-11-10 |
| Find all providers in zip 84113 | ||||
| Taxonomy Code | 2086S0120X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Pediatric Surgery |
| A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972620888 | Brian Thomas Bucher | Surgery | 100 N Mario Capecchi Dr Ste 2600, Salt Lake City, UT 84113-1103 | 2007-03-23 |
| 1790845873 | Syed Adil Husain | Surgery | 100 N Mario Capecchi Dr Ste 2200, Salt Lake City, UT 84113-1103 | 2006-12-11 |
| 1225119019 | Earl Courtney Downey Jr. | Surgery | 241 N Vine St Apt 906e, 906e, Salt Lake City, UT 84103-1926 | 2006-10-18 |
| 1740644319 | University of Utah Pediatric Services | Surgery | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-04-11 |
| 1205290053 | University of Utah Pediatric Services | Surgery | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-04-07 |
| 1144684994 | University of Utah Pediatric Services | Surgery | 100 N Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2016-04-07 |
| 1275790776 | Dale Gedge Johnson | Surgery | 100 N Mario Capecchi Dr, Suite 2600, Salt Lake City, UT 84113-1100 | 2008-05-21 |
| 1770707713 | Michael D Rollins II | Surgery | 100 N Mario Capecchi Dr, Suite 2600, Salt Lake City, UT 84113-1103 | 2007-04-12 |
| 1316028103 | Richard E Black | Surgery | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2006-10-18 |
| 1902996515 | Rebecka L Meyers | Surgery | 100 Mario Capecchi Dr, Salt Lake City, UT 84113-1103 | 2006-10-13 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84113 |
Please comment or provide details below to improve the information on UNIVERSITY OF UTAH PEDIATRIC SERVICES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.